QUESTION:
I recently had an issue in the dental office where I work. The associate doctor in my office totally misread an X-ray and gave the parent of the patient completely wrong advice. It wasn't even a question of there being two possible opinions. It was a complete misread of the teeth on the X-ray. I stood there flabbergasted and didn't know what if anything to do, so I did nothing. This dentist does not like "uppity" hygienists who are smarter than he is telling him he's wrong. What should I do in the future?
ANSWER FROM RACHEL WALL, RDH, BS, Founder and President of Inspired Hygiene, Inc.
I can imagine how frustrating this situation must have been. In the moment, I believe you did the right thing by not questioning the doctor's recommendation, especially if you don't have a strong relationship with him yet.
Our experience here at Inspired Hygiene has been that every client we've ever worked with has room to improve their team calibration. Being calibrated means anything from making sure you're all reading the probe the same way, to aligning your perio and restorative treatment philosophies. It's all about getting everyone on the same page, which increases team confidence in the doctor(s), doctor confidence in the team, and your patients’ confidence in all of you!
If I were in your shoes, I would approach the doctor in a friendly way. I would say something like, “Hi Dr. Smith, can I talk to you for a minute about a patient? Last week we saw this patient together and you reviewed the X-rays. I think I must have missed something and I'm hoping you can help me see what you see when you review the X-rays so we can be calibrated and I can understand your treatment philosophy. This way I can help prepare patients for your diagnosis. I remember you recommended (fill in the blank), and I'm confused because in this situation in the past, we've recommended (fill in the blank).”
I don't know what the specific recommendation was but it could be that the doctor is still refining his skills for moving quickly from one patient to another and made an error, or perhaps there's a difference in treatment philosophy. If his philosophy is a drastic departure from the owner doctor's, then a deeper conversation should occur between both docs. Either way, approach him from a place of “I’m here to help” and “Please help me understand.” Remember the old saying, you can catch a lot more bees with honey than with vinegar.
ANSWER FROM DR. JONATHAN BREGMAN, DDS, FAGD
I often deal with this issue of “what the hygienist sees” and “what the dentist sees.” What the hygienist sees as a really significant issue of health (i.e., a suspicious area in the soft tissue) that would warrant follow-up in his or her mind, the dentist may see as something that “We can watch for six months.”
The key is for the hygienist and dentist to sit down and have a conversation to answer an important question: How will we share information that I, the RDH, see during my exam (i.e., abnormal tissue, caries, periodontal pockets, defective restorations, etc.) with the dentist? What works for both the dentist and RDH in this “codiagnosis” conversation, considering that the RDH has so much time with the patient before the dentist walks in the door?
Some dentists want DDS/RDH findings to happen outside of the room before the dentist goes in to see the patient, with nothing discussed with the patient that the RDH has noted. To the other extreme is the RDH with post-it notes on the bracket tray about areas of concern that he or she has already spoken to the patient about. The key understanding is that the dentists’ recorded examination is the one that determines future treatment, treatment recommendations, and referrals. The RDH cannot diagnose by law.
I have also discussed with numerous RDHs that if the dentist’s approach to care does not fit with his or her own approach, the RDH should find an office where his or her philosophy of care and follow-up is shared. Along with that healthy environment is an open communication between dentist and hygienist.
With an associate dentist situation, it can become a bit dicey. Once again, it is important for the RDH to sit down with the associate dentist and have this conversation. Ultimately, if the RDH is concerned about the health of patients or malpractice related to an incompetent or sloppy associate, it is his or her duty to bring that to the attention of the host dentist.
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